Overview#
Typhoid fever is a systemic bacterial infection caused by Salmonella enterica serotype Typhi, transmitted through contaminated food and water (faecal-oral route). India has one of the highest burdens of typhoid globally, with an estimated 4.5-5 million cases annually. It is most common in areas with inadequate sanitation and unsafe drinking water. Children aged 5-15 years are disproportionately affected. Without treatment, typhoid can lead to intestinal perforation, a life-threatening complication.
Causes & Risk Factors#
- Salmonella typhi bacteria – transmitted through contaminated drinking water, street food, ice, and raw vegetables washed with unsafe water.
- Poor sanitation – inadequate sewage disposal and open defecation contaminate water sources.
- Contaminated food handlers – asymptomatic carriers can shed bacteria for weeks to months.
- Monsoon season – waterlogging and contamination of water supply increase transmission.
- Travel to endemic areas – rural India and areas with poor water infrastructure.
Signs & Symptoms#
- Step-ladder pattern of fever – gradual rise over 3-4 days, reaching 103-104 °F, sustained for 1-2 weeks
- Headache and body aches
- Abdominal pain, especially around the navel
- Constipation (more common than diarrhea in adults) or loose stools in children
- Loss of appetite and nausea
- Rose spots – faint pink spots on the chest and abdomen (seen in fair-skinned individuals)
- Coated tongue with red edges ("typhoid tongue")
- Relative bradycardia – pulse rate lower than expected for the degree of fever
Diagnosis#
- Blood Culture – the gold standard; positive in 60-80 % of cases during the first week. Book Blood Culture
- Widal Test – detects antibodies against S. typhi; rising titres (O ≥ 1:160, H ≥ 1:160) in paired samples are suggestive. Single Widal tests are unreliable due to high background positivity in endemic areas like India.
- Typhidot Test (IgM) – rapid and more specific than Widal for acute infection.
- Complete Blood Count – may show leukopenia (low WBC) and anemia. Book CBC
- Liver Function Test – mild elevation of transaminases is common. Book LFT
Treatment Options#
Antibiotics (based on sensitivity):
- First-line: Azithromycin (7 days) or ceftriaxone (IV, 10-14 days for complicated cases). These are preferred due to rising resistance to older drugs.
- Fluoroquinolones (ciprofloxacin) – once first-line but now have high resistance rates (> 60 %) in India. Avoid unless sensitivity is confirmed.
- Chloramphenicol, ampicillin, cotrimoxazole – historically used but resistance has made them unreliable.
- Multidrug-resistant (MDR) and extensively drug-resistant (XDR) typhoid is a growing concern in India. Blood culture with antibiotic sensitivity is crucial.
Supportive care:
- Adequate rest and hydration (ORS, soups, buttermilk).
- Soft, easily digestible diet – khichdi, dal water, curd rice, and boiled vegetables.
- Paracetamol for fever control.
- Avoid solid, spicy, or high-fibre foods during acute illness to reduce risk of intestinal perforation.
Prevention#
- Drink only boiled or purified water – use RO/UV-purified water at home; avoid ice from unknown sources.
- Eat freshly cooked food; avoid street food, cut fruits, and raw salads from outside during monsoon.
- Wash hands thoroughly with soap before eating and after using the toilet.
- Typhoid vaccine – available in India (Vi polysaccharide injectable or Ty21a oral). Recommended for children in endemic areas and travelers. Provides 50-80 % protection for 2-3 years.
- Ensure proper sewage disposal and avoid open defecation.
When to See a Doctor#
Consult a doctor if you have fever lasting more than 5-7 days, especially during or after monsoon season. Seek emergency care for severe abdominal pain (possible intestinal perforation), high fever unresponsive to paracetamol, blood in stool, or signs of dehydration (sunken eyes, dry mouth, reduced urination). Typhoid requires proper antibiotic treatment – do not self-medicate.